Term
| What are the 7 topographical landmarks of the chest? |
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Definition
Suprasternal/ jugular notch
Clavicles
Sternal angle (2nd rib comes off here)
Ribs
Intercostal spaces
Costal margin
Xiphoid process |
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Term
| Know where the following lines are: Mid sternal, mid clavicular, anterior axillary, mid axillary, posterior axillary, scapular (which goes through the angle of the scapula), and the vertebral line |
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Definition
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Term
___________________ contracts and moves downward during inspiration
__________________ muscles
increase the AP diameter during inspiration
____________________________
Decrease the lateral diameter during expiration |
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Definition
Diaphragm
contracts and moves downward during inspiration
External intercostal muscles
increase the AP diameter during inspiration
Internal intercostal muscles
Decrease the lateral diameter during expiration |
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Term
| Three major spaces of the thorax? |
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Definition
Pleural cavities
(Divided into R & L)
The mediastinum
(Contains all of the thoracic viscera except the lungs) |
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Term
Nipple falls within ____ intercostal space.
Horizontal fissure (separates upper and middle lobes) located at _____ rib. |
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Definition
Nipple falls within 4th intercostal space.
Horizontal fissure (separates upper and middle lobes) located at 4th rib. |
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Term
| What the normal respiration rate for adults? |
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Definition
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Term
Respiratory rates for children
Newborn 30 to 80 rpm
1 yo 20 to 40 rpm
3 yo 20 to 30 rpm
6 yo 16 to 22 rpm
10 yo 16 to 20 rpm
17 yo 12 to 20 rpm |
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Definition
Respiratory rates for children
Newborn 30 to 80 rpm
1 yo 20 to 40 rpm
3 yo 20 to 30 rpm
6 yo 16 to 22 rpm
10 yo 16 to 20 rpm
17 yo 12 to 20 rpm |
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Term
| Normal adults heart rate range? |
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Definition
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Term
Expected Children’s Heart Rates
Newborn = 120 – 170 bpm
1 yo = 80 – 160 bpm
3 yo = 80 – 120 bpm
6 yo = 75 – 115 bpm
10 yo = 70 – 110 bpm |
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Definition
Expected Children’s Heart Rates
Newborn = 120 – 170 bpm
1 yo = 80 – 160 bpm
3 yo = 80 – 120 bpm
6 yo = 75 – 115 bpm
10 yo = 70 – 110 bpm |
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Term
| 4 parts of the pulmonary exam |
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Definition
| inspection, palpation, percussion, auscultation |
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Term
| Inspect using proper lights for what 5 things? |
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Definition
Symmetry
Landmarks
(Skin examination)
Pulsations
AP diameter vs transverse diameter |
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Term
| Abnormality: Barrel chest is caused from? |
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Definition
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Term
| What is the Blue Bloater caused from and what are its symptoms |
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Definition
Chronic bronchitis predominately, COPD
The patient is not getting enough oxygen so they get blue (cyanotic) lips and fingers |
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Term
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Definition
Caused by: emphysema predominately, and COPD
It is an over compensation to gain enough oxygen |
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Term
| What is Pectus Carinatum? |
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Definition
Pigeon Chest-
Often associated with congenital heart disease.
Have less exercise tolerance, but are generally pretty healthy.
If caught early enough, you can brace these pt’s to make their chest grow laterally. |
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Term
| What is Pectus Excavatum? |
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Definition
Funnel Chest
Indenting on the right ventricle of the heart.
Have reduced stroke volume because the ventricle doesn’t fill like it is supposed to.
Has to be fixed surgically if pt is having CV problems or has cosmetic concerns. |
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Term
Define:
(Excessive) Kyphosis?
Gibbus?
Scoliosis? |
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Definition
(Excessive) Kyphosis
Deviation of the spine posteriorly
Gibbus
A marked kyphosis resulting in a hunchback deformity
Scoliosis
Deviation of the spine laterally |
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Term
| Make sure you palpate the bony thorax, feel the trachea and its position, and check chest expansion which is done by? |
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Definition
Chest expansion
Hands placed on posterior thorax
Thumbs at midline of lower thoracic region
Pt requested to inhale deeply as you observe expansion |
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Term
| What is Tactile Fremitus? How do you check it? |
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Definition
Palpable vibration of the chest during speech
Check by:
Palmar aspects of MCP of hands OR ulnar aspects of hands
Check bilateral simultaneously
Pt instructed to say “99” or “Mickey Mouse” each time hands moved
Vibration increased - consolidation, fluid in lung, solid mass
Vibration decreased - air trapping
check at multiple locations and in front and back |
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Term
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Definition
Do in a zig zag, top to bottom, medial to lateral pattern.
Check both sides at the same point.
Avoid bones.
compare sounds |
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Term
| percussion of the chest arm and should position for anterior and posterior? |
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Definition
For posterior chest have rounded shoulders, arms crossed in front
For anterior/axillary chest have arms resting or overhead |
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Term
Normal lung sound?
Added air?
Added density? |
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Definition
Normal lung should give off resonant tone (fairly hollow, but not quite like gastric bubble)
Added air will have more of an echo (hyperresonate)—pt with emphysema or COPD
Added density will give more of a dull tone- from cancer, effusion, or thickening |
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Term
| Make sure and know the location to palpate diagrams! |
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Definition
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Term
| Diaphragmatic Excursion by Percussion |
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Definition
Exam limited by COPD, pain, tumors, ascites, others.
Have patient breathe in and hold, percuss downward till you hear a it get dull. Then ask them to exhale and hold and percuss upward till hear a resonant sound. Should be about 3-6 cms. If less- could be trapping air. |
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Term
| turbulence to airflow is due to the _____ of the airways. |
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Definition
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Term
| The larger the airway the _____ the sound? |
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Definition
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Term
| Name the loudest to the softest: |
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Definition
| Tracheal (heard over the trachea) bronchial bronchovesicular vesicular (heard over most of the lung fields) |
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Term
| _______________ is normally longer than __________ |
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Definition
| inspiration is longer than expiration |
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Term
| Breath sounds (increase or decrease?) when normal lung is displaced by air (emphysema or pneumothorax) or fluid (pleural effusion) |
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Definition
| Breath sounds decrease when normal lung is displaced by air (emphysema or pneumothorax) or fluid (pleural effusion) |
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Term
___________ = extra sounds
are always abnormal, but not always significant |
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Definition
"Adventitious" = extra sounds
are always abnormal, but not always significant |
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Term
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Definition
Crackles (rales)
high-pitched, discontinuous sounds, similar to the sound produced by rubbing your hair between your fingers |
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Term
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Definition
Wheezes
generally high pitched, musical, whistling or sighing sounds |
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Term
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Definition
Rhonchi
snoring, gurgling or honking noise that is not a crackle or a wheeze is probably a rhonchus |
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Term
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Definition
Stridor
upper airway inspiratory obstructive “wheeze” associated with croup or epiglottitis |
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Term
| What are the three tests for vocal resonance? |
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Definition
Bronchophony
Whispered pectoriloquy
Egophony
Note: Factors affecting tactile fremitus will affect vocal resonance |
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Term
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Definition
During auscultation patient, says “99” or “Mickey Mouse”
Sound should be muffled
Positive bronchophony: Loud, clear spoken sound
Consolidation, pleural effusion |
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Term
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Definition
Whispers “99“ or “1,2,3”
Faint sound or nothing at all
If sounds heard clearly thru stethoscope and more prominent, whispered pectoriloquy is present |
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Term
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Definition
Pt says "E“ then you Auscultate multiple symmetrical areas over each lung (cover each lobe)
Normal is a muffled "E" sound;
Abnormal is an "ay" sound - referred to as "E to A“ or positive egophony |
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Term
| What to check in the elderly patient? |
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Definition
kyphosis, osteoporosis
AP diameter of chest
Percussion tone
Marked bony prominences
Easy fatigability
Chest expansion ability |
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Term
Temperature (T)
Degrees Fahrenheit and/or Celsius
Note location taken
Heart Rate (HR)
Include rhythm
Respiratory Rate (RR)
Include effort
Blood Pressure (BP)
Note which arm |
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Definition
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